Project Information

Project ID: 993608 DEA: 081H8204 EFIS: 0817000138 QA Service Level: 1

DIST-CO-RTE-PM: 08-SBD-15,138-R21.6,R14.8/R15.1

Work Description: SIGNAL AND LIGHTING SYSTEM, HMA, JPCP, AND ROADWAY EXCAVATION.

Location Description: SAN BERNARDINO COUNTY IN PHELAN ON ROUTE 138 FROM 0.3 MILE WEST OF ROUTE 138/15 SEPARATION TO ROUTE 138/15 SEPARATION AND ON ROUTE 15 SOUTHBOUND EXIT RAMP AT ROUTE 138

Contractor Name: EVERLEVEL HOLDINGS, LLC

Contractor Address: 5877 PINE AVE. SUITE 240, CHINO HILLS, CA 91709

Resident Engineer: Vu Thanh Nguyen Structure Rep.: Unknown

Sample Information

DIME Sample ID: 2023-04-20-9

TL Number from the TL Form:

Sample Submitted By Organization: CT D08 - Barstow Field Laboratory 1

Sample Organization Contact: (760) 252-9216

Type of Sample: Quality Assurance

Type of Material: Soil

Sample Taken Date: 04/20/2023

Date that the sample was received by the laboratory/organization performing the testing: 04/20/2023

The quantity of what the sample constitutes: 1000SQF

A brief description of the sample: CTM231 TEST 01

From where was the sample collected: Job Site

Laboratory sample identification: 04202023 TEST 01

Structure unique identifier:

Structure name:

The fabricator/manufacturer/facility name: AT THE JOB SITE

Material Information

The fabricator's/manufacturer's product name for the sample:

The fabricator/manufacturer designation for the sample:

A detailed description of where the material sample was collected: AT THE JOBSITE

Where the material sample would have been placed if not sampled:

Test Results

Test 1 of 2

DIME Test ID: 2023-04-20-9-1

Test Method: CTM 231-March 2013: Method of Test for Relative Compaction of Untreated and Treated Soils and Aggregates Using Nuclear Gages

Verified Date: 04/21/2023

Date Tested: 04/20/2023

Submitted By Organization: CT D08 - Barstow Field Laboratory 1

Organization Address: 13970 Victoria Street,

Organization City: Fontana

Organization State: CA

Organization Zipcode: 92336

Organization Email: kaushalkumar.talati@dot.ca.gov

Organization Phone: (951) 840-8328

General Comments for this Test:

Test Result Compliance: complies

Additional Comments When Verified:

Standard Count Density	1832 g/cc
Count or Density 1	954 g/cc
Count or Density 2	936 g/cc
Count or Density 3	987 g/cc
Standard Count Moisture	581 g/cc
Moisture Count 1	84 g/cc
Moisture Count 2	87 g/cc
Moisture Count 3	90 g/cc
Sum of Count or Density	2877 g/cc
Average of Count or Density	959 g/cc
Sum of Moisture Count	261 g/cc
Average of Moisture Count	87 g/cc
Count Ratio Density	0.52
Count Ratio Moisture	0.15
Calculated Percent Relative Compaction	96.4 %
Reported Percent Relative Compaction	96 %

Test 2 of 2

DIME Test ID: 2023-04-20-9-2

Test Method: CTM 216-June 2011: Method of Test for Relative Compaction of Untreated and Treated Soils and Aggregates